Provider Demographics
NPI:1467520015
Name:LAWRENCE, DAWNELLE M (SLP)
Entity Type:Individual
Prefix:
First Name:DAWNELLE
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 896114
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6114
Mailing Address - Country:US
Mailing Address - Phone:270-796-6800
Mailing Address - Fax:270-781-8228
Practice Address - Street 1:1751 SCOTTSVILLE RD STE 9
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3357
Practice Address - Country:US
Practice Address - Phone:270-202-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1760411342OtherGROUP NPI #
KY1760411342OtherGROUP NPI #
KYGROUP #91011148Medicaid